4 Orthopedic Implant and Device Developments

Lindsey Dunn -   Print  |
Here are four recent technological trends involving orthopedic implants and devices.

1. Mobile bearing partial knee replacement. In a partial knee replacement, surgeons modify part of the patient's knee to improve function instead of removing and then replacing the full knee, and mobile bearing partial knees are the latest technology for this type of procedure. Currently, partial knee replacement procedures are being performed by orthopedic surgeons as a "bridge" to a full knee replacement, says Jay Ethridge, CEO of Implantable Provider Group.

One of the first mobile bearing partial knee replacements to come on the scene was Biomet's Oxford Partial Knee System, says David Ott, MD, a board-certified orthopedic surgeon with Arizona Orthopaedic Associates in Phoenix. Unlike traditional fixed-bearing knee replacements, partial knees are mobile-bearing devices, he says. While Dr. Ott acknowledges that partial knees are commonly thought of as bridge procedures, he says a recent study out of the United Kingdom found 90 percent of partial replacements sustained their longevity 20 years after surgery, suggesting they could be as effective as total knee replacements.

2. Less invasive total knee replacement. While a number of other trends for total knee replacement have surfaced, including computer navigation and gender-specific implants, Dr. Ott says their popularity has waned as research suggests these technologies do not outperform traditional replacements. However, he says one trend in total knee replacement has remained steady — less invasive procedures.  

"While we may use the same general implants, what has transpired is that more and more [orthopedic surgeons] have looked at narrowing down the incision to reduce tissue damage, which can speed recovery time," says Dr. Ott. "Implants have been cut down a bit to make them easier to put in and instrumentation has gotten smaller."

3. Hip resurfacing. Just as a partial knee replacement seeks to avoid the full replacement of a knee, hip resurfacing is a bone sparing procedure sometimes used on younger patients as a means to possibly avoid a full hip replacement, says Mr. Ethridge. In this procedure, the "ball" of the hip is shaped and capped with a metal surface, as is the hip socket. Smith & Nephew's Birmingham HIP Resurfacing System is one of the most popular of these devices.   

While this procedure is gaining popularity, Dr. Ott cautions that very few patients are actually considered candidates for the procedure and there is presently very limited research suggesting this type of procedure is advantageous.

3. Anterior approach hip replacement. Total hip replacements are also trending toward less invasive techniques, and implants and surgical instruments have evolved to the point where these procedures can be performed using 3-6 inch incisions. However, another technique on the horizon that further reduces recovery time and is just beginning to gain greater popularity is the direct anterior approach to hip replacement. In this approach, a surgeon places the hip implant using an incision on the front of the patient, which goes between muscle planes as opposed to through muscle planes, as is done in the traditional posterior placement. The technique reduces muscle damage and improves patient recovery time, says Dr. Ott. Patients undergoing the anterior approach typically are discharged from the hospital in 1-2 days versus the 3-4 typically associated with a traditional hip replacement, and the anterior approach also reduces complications associated with dislocations and unequal leg length following procedures. Further, patients undergoing anterior approach replacements also are able to fully recover more quickly, moving from walkers to canes and then on to full independence more quickly than patients undergoing traditional procedures, says Dr. Ott.

Surgeons who use this approach typically use slightly modified implants and instrumentation to aid in anterior placement. Dr. Ott recommends that surgeons who perform the technique use a surgical table that allows a patient to be placed on his or her back and then extends the leg behind them, such as the Mizuho OSI ProFX or HANA Table. While the approach provides numerous benefits to the patient, Dr. Ott says it is a time-consuming and frustrating technique to learn, requiring as many as 20 procedures to become proficient.

"It's not for everybody, but it can benefit your practice," says Dr. Ott. "We have people coming to us from all over because they are doing consumer research and finding that we offer this approach. The physicians of our practice used to do maybe 10 hip replacements a month, and we are now doing around 55. Physicians around the country doing these are seeing their hip volumes doubling and tripling."

4. Biologics. A final area in orthopedics that has recently increased in popularity is biologics. These types of therapies include the use of human tissue, or allografts, to repair damaged tissue, such as tendons. Within orthopedics, this therapy is most used in ACL reconstructions, says Mr. Ethridge. Another type of therapy growing in popularity is platelet rich plasma injections, where a patient's own platelets are injected to repair damaged areas, such as an inflamed tendon, says Dr. Ott. However, Dr. Ott is concerned there is not data to prove the effectiveness of such injections and cautions against using therapies without evidence of its advantages.

Growth in sector
As baby boomers age, more patients will be in need of orthopedic implants, and the implant sector is expected to continue to grow as a result, says Mr. Ethridge. He cautions, however, more clinical data is needed to help physicians make appropriate decision for their patients.

"From an industry standpoint, there needs to be a greater focus on providing more comparative effectiveness data regarding procedures and devices to substantiate these new procedures being performed," says Mr. Ethridge.

Contact Lindsey Dunn at lindsey@beckersasc.com.



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